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Entries in dehydration
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We have seen a large number of pitiful patients in the past two weeks with a gnarly stomach bug. Most of these kids have had vomiting for just a couple of days but then lingering stomach aches and diarrhea for 1-2 weeks. And a lot of these kids, more than we typicaly see, have gotten dangerously dehydrated (some even are requiring hospitalization for IV fluids).

So I was preparing to write this blog post last week with all my pediatrician tips for how to help your child through a stomach bug....and then it hit at my house! Luckily, we avoided a trip to the hospital, but now I'll add a few practical tips from my very recent personal experience of caring for my own vomiting child.

What is a stomach bug? Though many refer to this as "stomach flu," it is NOT truly flu (as in influenza). Instead, the medical term for a stomach bug is "viral gastroenteritis" which simply means a virus that attack the small intestine causing abdominal pain, vomiting, diarrhea, and sometimes fevers. Many viruses could cause gastroenteritis including Rotavirus (which we have a vaccine for but still can cause disease in some kids), Norovirus, Adenovirus, etc.

What happens if your child gets a stomach bug? Typically, a child starts with nausea (in smaller kids they may be more fussy and lose their appetite) and possibly a fever. Vomiting occurs the first couple of days and then diarrhea comes next and may last up to 2 weeks. Not all children get both vomiting and diarrhea. Some children have no fever. And although we say the vomiting only lasts a day or two, some particularly strong strong viruses can cause more severe symptoms and the vomiting may persist for several days OR if a child tries to eat or drink too much while their stomach is still upset, they may begin vomiting again.

Where did the stomach bug come from? This can be very difficult to pinpoint because a child can become sick anywhere from 12 hours to 4 days after being exposed to the virus. Infected patients are most contagious to others while they are running a fever or vomiting, but unfortunately some of these viruses can be passed on even 1-2 weeks after a patient's symptoms have resolved.

What can you do to help your child with a stomach bug?

1. Push fluids SLOWLY: I saw first hand last week who heartbreaking it can be to watch your thirsty child beg for more drink after vomiting but if you let them drink too much, too quickly, you'll just trigger more vomiting. The key is to go very slowly (start with just a teaspoon every 5-10 minutes, then increase to 1/2 an ounce every 20 minutes or so for the first hour). For small children, use a syringe to give 10 mL (which is 1/3 of an ounce) if you must. After an hour, you can increase up to 1-2 ounces every 20-30 minutes. After two hours since they last threw up, you can double the amount up to 2-4 ounces every 20-30 minutes.

For an infant who is vomiting, we recommend continuing to breast or bottle feed if possible. So if you are still breastfeeding, give them 20-30 minutes after vomiting and then nurse them (this is comforting plus heps restore the nutrients they lost).

For older children or infants over 4-6 months who are refusing their milk, try Pedialyte (a special formula with extra salt and less sugar that helps replace the nutrients a child's body needs after vomiting and diarrhea).

If your child hasn't vomitted for at least 6 hours or so, you can move beyond "clear liquids" to milk. After 8 hours of no vomiting, it's okay to try solid foods.

Stay away from herbal teas and sodas as the caffeine can worsen dehydration. Also, full strength fruit juice has a lot of sugar and can sometimes make diarrhea worse, so dilute it down to half-strength (or mix it with unflavored Pedialyte).

We doctors now believe that the traditional BRAT diet (bananas, rice, applesauce, and toast) that we used to recommend for diarrhea actually doesn't give kids enough protein or calories. But remember to limit high-fat foods like chicken fingers and ice cream, which are harder to digest (may be thrown back up) and avoid spicy foods and fruit juices, which can irritate the gut and cause worsening stomach aches.

3. Give probiotics: Probiotics are live microorganisms (good bacteria) used to restore the balance of normal intestinal bacteria which is often wiped out with diarrhea. Some studies have shown that probiotics can shorten the severity and duration of diarrhea. Probiotics are especially important for children with bad diarrhea (more than 6-8 stools per day) or diarrhea lasting more than 2-3 days. I don't recommend any particular brand (common brands include Culturelle, BioGia, Florastor) but recommend child dosing (usually half the adult dose) for kids under 12 years. Probiotics come in liquid form or powder that can be sprinkled into a drink and served wtihin 20-30 minutes. Give probiotics 1-2 times per day until your child's diarrhea resolves.

DO NOT use any anti-diarrheal medications which can make children with diarrhea a whole lot sicker!

4. Watch for Red Flag signs that may signal dehydration or another serious problem:

Signs of dehydration:

- Decreased urination (fewer than 3-4 wet diapers in 24 hours for infants and not urinating for more than 12 hours for older children).

- Not making tears when they cry

- Dry, cracked lips

- Feeling dizzy when standing up

If your child is still playful and active, he or she is not dehydrated. If you're concerned your child may be dehydrated, please call the office.

2. Wash their bedding, clothes, etc in hot water and dry on high heat.

3. Wash hard surfaces frequently with disinfecting wipes.

4. Don't share utensils, cups, pillows, or towels.

Other miscellaneous tips:

- Take Cover! If your child is in a crib, try putting an extra waterproof mattress cover on the crib and an extra sheet (so you can just peel off the top sheet and cover if your child vomits in the crib in the middle of the night). For older children, cover everything with towels - the bed, the couch, the floor beneath, pillows, anything within range that will be a pain to clean. Have a stack of spare towels ready for when the old ones need to be changed. And even drape a towel on yourself before you scoop up your puking child. This way you don't have to change clothes too every time they throw up and you're whisking them to the bathrrom.

- Empty a laundry basket and keep it nearby to toss in the dirty towels and clothes. Then later you can throw everything into a heavy wash together when you have a minute.

- Use Pedialyte freezer pops to help quench your child's thirst but keep them from drinking too much too quickly. Have them hold it with a small hand towel so that their fingers don't get too cold.